Set 4 Flashcards by Ernst Fattakhov

Oligohydramnios is when the single deepest pocket is less than ______

< 2cm

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How to manage acute bleeding in vWF deficiency.

Desmopressin

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What 3 tests are used to diagnose vWF deficiency.

1) vWF antigen level
2) Factor VIII level
3) vWF activity (ristocetin cofactor activity)

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Borderline personality disorder best form of psychotherapy.

Dialectical behavior therapy

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Antipsychotic extrapyramidal effect: Acute Dystonia
Symptoms?
Tx?

Acute Dystonia Symptoms = Sudden sustained contraction of eyes, neck, mouth, tongue
Tx = Benztropine, Diphenhydramine

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Antipsychotic extrapyramidal effect: Akathisia
Symptoms?
Tx?

Akathisia symptoms = restlessness, inability to sit still

Tx = Beta blocker, Benzodiazepine, Benztropine

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Antipsychotic extrapyramidal effect: Parkinsonism
Symptoms?
Tx?

Parkinsonism symptoms = Tremor, rigidity, bradykinesia

Tx = Benztropine, Amantadine

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Antipsychotic extrapyramidal effect: Tardive dyskinesia
Symptoms?
Tx?

Tardive Dyskinesia symptoms = Dyskinesia of mouth, face, trunk and extremities (after > 6 month of therapy)
Tx = Valbenazine, Deutetrabenazine

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Nausea, vomiting and early satiety in a type 2 diabetic. Dx? Tx?

Dx = Diabetic autonomic  neuropathy of the GI tract results in delayed gastric emptying
Tx = Metaclopramide (a prokinetic agent)

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What is the NEXT STEP if neonate has billous emesis and X-ray shows dilated loops of bowel.

NEXT step: contrast enema to differentiate between Meconium Illeus and Hirschsprung’s Disease.

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Treatment of Meconium ileus

Hyperosmolar enema (Gastrografin) to break up the inspissated meconium

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Compare and contrast 5-alpha-reductase deficiency and Androgen insensitivity syndrome?

Both 5-Alpha-Reductase Deficiency and Androgen Insensitivity Syndrome present as females with male internal genetelia (testes).
The difference is that patients with Androgen Insensitivity Syndrome will develop breasts. 5-Alpha-Reductase Deficiency patient will not.
At puberty patients with 5-Alpha-Reductase Deficiency will develop Clitoromegaly.

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At what gestational age to test for Anti-D immune globulin?

28-32 wks

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At what gestational age to test for Group B Strep?

35 - 37 wks (test is valid for 5 wks)

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If suspecting an ectopic pregnancy but transvaginal ultrasound is negative then what is the next step in management.

Serial beta-HCG – repeating every 2 days until beta-HCG is more than 1500. Then repeat transvaginal ultrasound.
(if beta-HCG is trending down then this is a miscarriage)

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Best test to diagnose Bronchiectasis.

HIGH RESOLUTION CT

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Loss of urine when lifting. What type of urinary incontinence is this? Treatment?

Stress Urinary Incontinence

Tx = Kegal exercises

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Sudden urge to void followed by immediate loss of urine. What type of urinary incontinence is this? Treatment?

Urgency Incontinence

Tx = anticholinergics and timed voiding

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Edema and narrowing of the proximal trachea. Dx?

Dx = Croup (laryngeotracheitis)

-> this is why you get the steeple sign

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Edema of the epiglotis and aryepiglotic folds. Dx?

Epiglottitis (Haemophilus influenzae b)

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Laryngeotracheitis. Tx?

Laryngeotracheitis = Croup
Tx = corticosteroids (dexamethasone) to decrease airway edema
If severe then Tx = nebulized epinephrine

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Persistent patent processus vaginalis. Dx?

Hydrocele

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Back pain in a patient in 20s and 30s. What diagnosis to suspect? Best test to establish diagnosis?

Dx to suspect = Ankylosing spondylitis

Test = X-ray of the sacroiliac joints

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3 step mechanism of diabetic nephropathy.

1) Glomerular Hyperfiltration
2) Thickening of glomerular basement membrane
3) Nodular sclerosis

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In constrictive pericarditis -- what do you see on jugular venous pulse tracing?

Prominent x and y descent

When to use unsynchronized cardioversion.

Ventricular fibrilation | Pulseless ventricular tachycardia

Why may PT be elevated in exertional heat stroke?

because exertional heat stroke can cause DIC

Acute right upper quadrant pain in an alcoholic patient.

Alcoholic hepatitis

Staghorn calculi in the kidneys are caused by what organisms.

Urease-producing organisms (Proteus, Klebsiela) | NOT E. coli

Loss of maternal copy of 15q11-q13. Dx?

Angelman

Loss of paternal copy of 15q11-q13. Dx?

Prader-Willi

Disregulation of imprinted gene expression on chromosome 11p15. Dx? Key Symptoms?

Dx = Beckwith-Wiedemann syndrome | Key symptoms = Hemihyperplasia, umbilical hernia / omphalocele

Nondisjunction resulting in an extra X chromosome. Dx? Key symptoms?

XXY = Kleinfelter | Key symptoms = small testes, tall stature

X-linked mutation of the fragile X mental retardation 1 gene. Dx? Key symtpoms?

Dx = Fragile X | Key symptoms = large testes, prominent forehead

X-linked mutation of the hypoxanthine-guanin phosphoribosyl transferase gene. Dx? Key somptoms?

Dx = Lesch-Nyhan | Key symptoms = hyperuricemia, self-mutilation

Enlargement of submandibular glands. Dx? Causes?

``` Dx = sialadenitis Causes = liver disease (alcoholic or non-alcoholic), malnutrition (diabetes, bulimia) ```

3 Symptoms of Vit A deficiency

- Impaired night vision - Dry eye - Keratinezation of conjunctiva and cornea

Size of endometrial stripe that makes you suspect malignant proliferation of the endometrium.

> 4 mm

What vaginal pH helps to confirm menopause and why?

Vaginal pH > 5 suggests menopause | Low estrogen -> low glycogen -> low vaginal lactobacilli activity -> less acid, higher pH

Panic disorder treatment

Primary: SSRI/SNRI + CBT Acutely: Benzodiazepines

What psychiatric condition is treated with beta blockers?

Performance anxiety

What is the most significant risk factor for preterm labor?

Previous preterm labor

Fasting serum gastrin level is a test used to diagnose what condition?

Dx = Gastrinoma (Zollinger-Ellison syndrome) | gastrin level > 1000 pg/mL

What are the endoscopic findings associated with Gastrinoma (Zollinger-Ellison syndrome)

- prominent gastric folds | - ulcers in multiple areas in GI

Glucocorticoid-induced myopathy. | Normal or high ESR, CK?

Normal ESR | Normal CK

Polymyalgia rheumatica. | Normal or high ESR, CK?

High ESR | Normal CK

``` Inflammatory myopathy (polymyositis, dermatomyositis). Normal or high ESR, CK? ```

High ESR | High CK

Statin-induced myopathy. | Normal or high ESR, CK?

Normal ESR | High CK

Hypothyroid myopathy. | Normal or high ESR, CK?

Normal ESR | High CK

Metabolic abnormalities that can be caused by hypothyroidism.

Hyperlipidemia | Hyponatremia

What are non-thyroid lab findings that are found in Hypothyroidism?

High Lipids High Creatinine Kinase High Serum Transaminases Low Sodium

Clicking sensation and a burning pain when the 3rd and 4th metatarsal heads are squeezed together. Dx? Mechanism?

``` Dx = Morton Neuroma Mechanism = Neuropathic degeneration of the interdigital nerves ```

Urinanalysis in ethylene glycol poisoning

Envolope-shaped calcium oxalate crystals

Mechanism of the following side-effect of glucocorticoids: leukocytosis

Glucocorticoids cause mobilization of marginated neutrophils into the bloodstream.

Dextromethorphan. Use? Side effect?

Use = Antitussive Side effect = - mild abuse potential (it is a codeine analogue) - may cause seratonin syndrome if combined with other meds - false negative drug screen for PCP

Penetrating injury to one eye, later develops into damage of the other eye. Dx? Mechanism?

``` Dx = Sympathetic ophthalmia Mechanism = Immunologic mechanism involving the recognition of "hidden" antigens ```

Patient with pneumocystis pneumonia. Tx?

``` Tx = TMP-SMX +/- corticosteroids Give corticosteroids IF: PaO2 < 70 Alveolar-arterial ratio >35 ```

Mechanism of hepatic hydrothorax.

Alcoholic develops hydrothorax due to low albumin levels. Hepatic hydrothorax results in transudative pleural effusions that pass through defectc in the diaphragm.

Give GBS prophylaxis if rupture of membrane is longer than _____

18 hrs

Cyclosporine (immunosuppresant) side effects

``` Nephrotoxicity Hyperkalemia Hypertension Tremor Gum Hypertrophy Hirsutism ```

Tacrolimus (immunosuppresant) side effects

``` Nephrotoxicity Hyperkalemia Hypertension Tremor NO gum hypertrophy NO hirsutism ```

Azathioprine (immunosuppresant) side effects

Diarrhea Leukopenia Hepatotoxicity

Mycophenolate (immunosuppresant) side effects

Bone marrow suppression

Most common cause of syncope after MI.

Reentrant ventricular arrhythmia

If a varicocele fails to reduce in the recumbent position then this should suggest what diagnosis?

Renal cell carcinoma

Most sensitive and specific test to diagnose renal cell carcinoma.

CT scan of abdomen

Most common cause of proteinuria in Hep B infected individual.

Membranous nephropathy

Chlamydial conjunctivitis timetable for neonates. vs Gonococcal conjunctivitis timetable

Chlamydial conjunctivitis presents 5-14 days after birth. | Gonococcal conjunctivitis presents within the 1st week of life.

Chlamydial conjunctivitis treatment?

Oral Azithromycin

What is the treatment for Strep mutans infective endocarditis if the organism is susceptible to penicillin.

IV penicillin G or IV ceftriaxone

What are the target blood glucose levels for patients with gestational diabetes? Fasting, 1 hr and 2 hr postprandial

Fasting < 95 1 hr postprandial < 140 2 hr postprandial < 120

Treatment for postpartum endometritis

Clindamycin + Gentamycin

For prerenal acute kidney injury what is the BUN/CR, Urine sodium, Fractional excretion of sodium.

BUN/CR > 20 Urine sodium < 10 Fractional excretion of sodium < 1%

For intrarenal acute kidney injury what is the BUN/CR, Urine sodium, Fractional excretion of sodium

BUN/CR < 10 Urine sodium > 20 Fractional excretion of sodium > 1%

What are the 3 auscultory findings for aortic stenosis?

1) Diminished and delayed carotid pulses ("pulses parvus et tardus") 2) soft and single s2 3) Systolic murmur. a) If aortic stenosis is mild then the systolic murmur is: early peaking b) If aortic stenosis is severe then the systolic murmur is: Late-peaking crescendo-decrescendo

Apical mid-diastolic murmur. Dx?

Mitral stenosis | heard after opening snap

What chronic valvular defects can cause S3 and S4.

``` S3 = chronic mitral or aortic regurgitation S4 = chronic aortic stenosis ```

Loud S1. Dx?

Mitral stenosis

2 conditions associated with acanthosis nigricans.

1) insulin resistance | 2) gastrointestinal malignancy

What is associated with the following skin condition? Porphyra cutanea tarda

Hep C

What is associated with the following skin condition? | Dermatitis herpetiformis

Celiac disease

What is associated with the following skin condition? | Psoriasis

HIV and Streptococcal pharyngitis

What is associated with the following skin condition? | Severe seborrheic dermatitis

HIV and Parkinson's disease

What is associated with the following condition? | Explosive onset of multiple itchy, seborrheic keratoses

Gastrointestinal malignancy | -> this is called Lesser-Trelat sign

What is associated with the following condition? | Pyoderma gangrenosum

Inflammatory bowel disease

Skin findings associated with Sarcoidosis

``` Erythema nodosum (tender anterior tibial nodules) and Lupus pernio (violaceous facial papules or nodules) ```

What 2 skin conditions are associated with Gastrointestinal malignancy?

1) Acanthosis nigricans (velvety thickening of skin in the neck or axillae) 2) Lesser-Trelat sign (explosive onset of numerous seborrheic keratoses)

3 dermal signs associated with hepatitis C.

1) Porphyria cutanea tarda (blisters and scars, generally on sun-exposed areas) 2) Lichen planus (4Ps: purple, pruritic, polygonal papules/plaques) 3) Cryglobulinemic vasculitis (erythematous lower extremity papules or macules)

What conditions are associated with the skin condition vitiligo (hypopigmentation due to the autoimmune destruction of melanocytes)?

Chronic lymphocytic thyroditis (Hashimoto) and Graves Disease

What is the serum osmolarity and urine osmolarity in SIADH?

Serum osmolarity < 275 | Urine osmolarity > 100

Guideline for treatment of hyponatremia.

Na < 135: if asymptomatic or mild symptoms (lethargy, forgetfullness) -- fluid restriction (<800 mL/day) Na < 120 OR severe symptoms (seizure, coma) -- hypertonic (3%) saline -- correction must be < 8 mEq over first 24 hrs to avoid osmotic demyelination syndrome

Most common cause of cor pulmonale.

COPD

Compare and contrast cor pulmonale and cirrhosis.

Both Cor Pulmonale and Cirrhosis cause elevated JVP. In Cor pulmonale the liver is always enlarged, In Cirrhosis the liver in shrunken or fibrotic.